1. Home
  2. Directory
  3. Illinois
  4. Peoria
  5. Physician Assistant
  6. NPI Profile

MR. KIM KEITH WIESE PA-C
NPI 1801866744
Physician Assistant in Peoria, IL

Active since January 24, 2006PECOS Enrolled
1524 W GLEN AVE, PEORIA, IL 61614(309) 512-0902(094) 030-3973 Get Directions Write a Review

NPPES record last updated: May 19, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 19, 2020, Jan 30, 2019 (2 updates tracked since 2019).

About Mr. Kim Keith Wiese Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KIM KEITH WIESE PA-C (NPI 1801866744) is an individual physician assistant in Peoria, Illinois, licensed in Illinois (085.006503) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1801866744
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. KIM KEITH WIESECredential: PA-C
Location Address1524 W GLEN AVEPeoria, IL 61614-4692
Mailing Address1524 W Glen AvePeoria, IL 61614-4692 · (309) 512-0902 · Fax (309) 403-0397
Phone(309) 512-0902
Fax(094) 030-3973
Sole ProprietorNo
Enumeration DateJanuary 24, 2006
Last NPPES UpdateMay 19, 20202 updates tracked since enumeration
NPPES CertifiedMay 19, 2020
✔ NPI 1801866744 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in IL · 085.006503
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1524 W GLEN AVE, Peoria, IL 61614
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kim Keith Wiese Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61614 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BENNINGFIELD & ASSOCIATES, LLC
Chiropractor
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 692-6800
MARK K WERKING, DC, SC
Chiropractor
1524 W GLEN AVE, STE B
PEORIA, IL 61614
Peoria County (309) 692-2121
MS. AMBER KAY JONES MSN, APRN, FNP-BC
Nurse Practitioner (Family)
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 512-0902
DR. ROBERT CRAIG BENNINGFIELD DC
Chiropractor
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 692-6800
DR. SCOTT C FENWICK DC
Chiropractor
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 692-6800
DR. JASON RYAN BENNINGFIELD D.C.
Chiropractor
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 692-6800
MRS. MEGHAN K CHOCKLEY PT
Physical Therapist
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 692-6800
EVERSIDE HEALTH, LLC
Clinic/Center (Primary Care)
1524 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 512-0902

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Wiese's NPI number?

The NPI number for Kim Wiese is 1801866744. It was assigned to this individual provider in the NPPES registry on January 24, 2006.

Where is Kim Wiese located?

Kim Wiese practices at 1524 W Glen Ave, Peoria, IL 61614. The listed phone number is (309) 512-0902.

What is Kim Wiese's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kim Wiese enrolled in Medicare?

Yes. Kim Wiese is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kim Wiese was last updated on May 19, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.